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The page below is a sample from the LabCE course The Toxicology Laboratory's Role in Pain Management: Testing for Opiates. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Pain Management Contracts

When patients see a clinician to manage their pain they are, by definition, pain management patients. The practice of pain management is more involved than simply prescribing analgesics. Although all primary care providers practice some level of pain management, Pain Management is also a distinct medical discipline with a specific training fellowship. Addiction Medicine is another relatively new area of medical specialty that relies heavily on DOA testing and, like Pain Management may be a separate department composed of specialized physicians. We will discuss the goals of pain management in coming sections.
The concept of a "pain management contract," or an "opiate therapy plan" is important to mention. When a patient's pain is going to be managed with opiates or other prescription analgesics the patient and clinician must agree to the terms of this treatment. A contract or document of understanding is often used to clearly express the expectations the provider has of the patient with regard to their medication compliance.
Opiates are narcotics. A narcotic can refer to any drug derived from opium or opium-like compounds. These drugs have potent analgesic effects and can cause alterations in mood and behavior. Narcotics also have the potential for dependence and tolerance with repeated administrations. Since these are strong drugs, an agreement can be very useful, such therapy contracts have provisions such as:
  • The patient will not seek medications from other providers.
  • The patient will only use medications that are provided to him/her.
  • The patient will not sell or give his/her medications to others.
These contracts are important to establish trust and outline expectations between the clinician and the patient. These contracts will often also specify the requirements for routine urine drug testing.